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Morbidity Associated with Concomitant Thyroid Surgery in Patients with Primary Hyperparathyroidism

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Recurrent laryngeal nerve (RLN) palsy and hypoparathyroidism are serious complications in thyroid and parathyroid surgery. The extent to which incidentally detected thyroid nodules should be treated concomitantly is a matter of debate.

Methods

This analysis was based on 1,065 patients who underwent consecutive surgery for primary hyperparathyroidism at a single institution. Together with the surgical strategy, histologic and follow-up examinations were documented prospectively and analyzed retrospectively regarding the occurrence and course of RLN palsy, hypoparathyroidism, and thyroid carcinoma.

Results

Altogether, RLN palsy occurred for 38 patients (3.6 %) and proved to be permanent for 1 patient (0.1 %). Postoperative calcium substitution was necessary for 191 patients (17.9 %), with 3 patients showing permanent hypoparathyroidism (0.3 %). Procedures other than open minimally invasive exploration were accompanied by a significantly increased risk for temporary RLN paresis (odds ratio [OR], 6.136) and temporary hypoparathyroidism (OR 3.306). Concomitant thyroid surgery was performed for 502 patients (47.1 %). Compared with open minimally invasive parathyroid exploration, patients undergoing unilateral exploration and hemithyroidectomy (OR 5.827) or bilateral neck exploration (BNE) and thyroidectomy (OR 8.047) had a significantly increased risk for RLN paresis. Patients administered BNE with hemithyroidectomy (OR 2.380) or thyroidectomy (OR 7.233) had a significantly increased risk for hypoparathyroidism. Thyroid malignancy was incidentally detected in 86 patients (8.1 %).

Conclusion

Patients undergoing concomitant thyroid procedures have a significantly higher risk for temporary RLN palsy and hypoparathyroidism. However, the high rate of incidentally detected thyroid carcinoma in an iodine-replete endemic goiter area indicates hemithyroidectomy in the presence of thyroid nodules incidentally identified in preoperative ultrasounds.

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Authors and Affiliations

  1. Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria

    Philipp Riss MD, Andreas Selberherr MD, Christian Scheuba MD & Bruno Niederle MD

  2. Center for Medical Statistics, Informatics, and Intelligent Systems (CeMSIIS), Medical University of Vienna, Vienna, Austria

    Michael Kammer DI

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  1. Philipp Riss MD
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Correspondence to Philipp Riss MD.

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Riss, P., Kammer, M., Selberherr, A. et al. Morbidity Associated with Concomitant Thyroid Surgery in Patients with Primary Hyperparathyroidism. Ann Surg Oncol 22, 2707–2713 (2015). https://doi.org/10.1245/s10434-014-4283-4

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  • DOI: https://doi.org/10.1245/s10434-014-4283-4

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